About usClinical negligence scheme for general practice - what you need to know

Clinical Negligence Scheme for General Practice - what you need to know

THE UK Government has introduced a Clinical
Negligence Scheme for General Practice (CNSGP) in England from April 2019 and General Medical Practice Indemnity (GMPI) for GPs in Wales. This ‘information hub’ contains a
range of different information and articles about CNSGP/GMPI, what it means for our
members, where MDDUS stands in relation to this scheme and the work we are
doing to ensure we influence the best outcome for our members and their patients.

Further details of a state-backed indemnity scheme (SBIS) for GPs have been released as the Government launches a new five-year contract for general practice across England. This will now be known as the Clinical Negligence Scheme for General Practice (CNSGP). It started on 1 April 2019 and is operated by NHS Resolution.

All NHS GP service providers in England including out-of-hours provision will automatically become members of the scheme and will not have to pay a subscription for membership. Government has confirmed that the scheme will be funded through a one-off permanent adjustment to the global sum but investment in the practice contract overall will still rise by 1.4 per cent in 2019/20 even after accounting for the indemnity change. Non-recurrent funds will be paid to practices for the 2018/19 increases in indemnity costs.

The Welsh Government has announced that NHS Wales Shared Service Partnership – Legal and Risk Services will operate the General Medical Practice Indemnity (GMPI) for GPs in Wales in relation to clinical negligence claims arising from 1 April.

Why you still need an MDO

Remember that GPs will still need MDDUS to provide comprehensive protection that the new CNSGP and FLS alone won’t deliver. You can find out more about why you should remain a member of MDDUS here.

MDDUS’ General Practice Protection (GPP) membership provides GPs working within the NHS in England and Wales with a range of essential benefits that are not included in CNSGP and GMPI. Find out more about our essential new product for GPs in England and Wales here.

CNSGP and GMPI will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations and will also not include advice and support –something highly prized by MDDUS members. This is evidenced by the fact that over the past 12 months, MDDUS’ team of expert medical advisers handled over 6,500 calls and opened nearly four thousand new case files from GP members relating to issues NOT included in the government scheme.

As these figures show, there are a huge range of areas where GPs will not get support from the new scheme and as a result will need to ensure they remain in membership of MDDUS in-order that they have access to expert assistance and support. Your MDDUS membership is annual and our service for non-claims continues beyond the 1 April 2019 until your renewal date. Your subscription fees will be lower for this period and a refund will be provided to you if required. We will still be there for you.

That’s why the BMA recently reminded GPs of the importance of retaining their MDO subscription when CNSGP is introduced. Advice from the BMA states that “MDOs will continue to play an important role” and “it will be essential to maintain medical indemnity.”

You can also read our response to the Department of Health and Social Care (DHSC) announcement on the new GP contract from MDDUS CEO Chris Kenny here.

Since CNSGP was announced in October 2017, MDDUS has constantly highlighted the need to protect the global sum from the cost of the future liabilities scheme (FLS). We have continually lobbied for this, so we welcome the commitment to fully fund the FLS now and in future years.

This commitment to funding 2018/19 increases and the FLS in future years is crucial as the costs of indemnity will continue to rise in the absence of any meaningful tort reform measures. CNSGP will not slow the rate of increase in indemnity costs without legal reform and may indeed increase pressure as claimant solicitors “try their luck” with a new organisation, so increasing cost pressures in the long-term. It is key that the proposed joint work monitors this to ensure primary care monies are not diverted from frontline services to fund these increases.

Remember that GPs will still need MDDUS to provide comprehensive protection that the new CNSGP alone won't deliver.

What’s important now is that GPs receive more information about how the new scheme will operate and particularly any workload impact on practices in handling claims. Much operational detail is still missing and we are working hard to explain to NHS Resolution the operational issues where more certainty is needed quickly.

Fragmenting the integrated service offered by MDOs is an inevitable consequence of this change. We are concerned that there is a real danger that NHS Resolution may face pressure to put the financial interests of the service ahead of the protection of the professional reputation of the GP. MDDUS continues to press for the clearest possible commitments on this when we meet DHSC and NHS Resolution to hear more about their operating model.

The rising cost of indemnity has been a major issue for GPs in England and Wales. MDDUS believes that the reasons for this are down to Government’s failure to take decisive action to reduce the increasing number and value of claims and the addition of significant new cost by the misguided lowering of the discount rate to -0.75%.

We and the rest of the MDO sector continue to urge action on these issues, which CNSGP does nothing to tackle. Indeed, dependent on the model chosen, it may well increase claims costs and numbers.

As a ‘not-for-profit-mutual’ funded by our own members with no shareholders to pay, we have been able to keep our costs as low as we can, ensuring adequate indemnity for all our claims: historical, current and future. We will maintain this commitment to our members buying our new product to cover them for non-NHS work.

What are we doing?

MDDUS shares Government’s objective of driving down the cost of indemnity for GPs, but wants to do so in a way that retains standards, GP centrality and GP choice. As it stands, much of what is proposed remains unknown and information has been slow in coming out about what exactly is proposed.

MDDUS has been speaking with Government officials and with the politicians and decision makers to ensure any scheme is best for our members and patients: past, present and future. The claims experience of GPs differs very markedly across the different parts of the UK and we do not see anything like the same strength of case for action in Scotland and Northern Ireland as in England and Wales. Reimbursement of subscriptions would have been a far more effective solution than nationalisation ever can be and we will be watching the progress of the centralised scheme carefully to check that our members are not being penalised.

We will continue to lobby and engage with key influencers about the scheme and ensure that the views of members and patients are at the forefront of the decision-making process.
Visit our Media Centre and follow us on Twitter on @MDDUS_News to keep up-to-date with the latest news.

Find out more

We have worked hard to answer as many questions as we can on what the scheme may look like based on the limited information we have. You can click below to read our FAQs.

If you have a question that is not answered here then please contact us on membership@mddus.com where we will give you a personal response. We will update our FAQs with any new and relevant questions posed.

WHAT DO WE KNOW ABOUT THE CLINICAL NEGLIGENCE SCHEME FOR GENERAL PRACTICE (CNSGP)?

The Government has said the new scheme will provide GPs in England with indemnity against clinical negligence claims arising from NHS contracted work. It will extend to all GPs and all other staff working in delivery of primary medical services. It will automatically cover contractor and salaried GPs, GP locums, GPs in training and other schemes such as retainers, prison GPs, nurses, allied health professionals and the wider NHS primary care work, including out-of-hours cover. The Welsh Government plan to implement a similar scheme to that planned for England. Close

As yet there are no final details on how the scheme will work, but the DHSC has confirmed the scheme will be administered and run by NHS Resolution and will cover clinical negligence liabilities for work carried out as part of their NHS contract. It will cover providers on GMS, PMS, APMS and standard NHS contracts and provide indemnity for clinical negligence for all staff including students and trainees. GPs will therefore be covered through the GP practices that they work in, rather than individually as is now the case.

Government is committed to funding the FLS now and in future years.
It is still unclear whether and if so how the new state-backed scheme will take on responsibility for historic claims - i.e. cases that are ongoing when the scheme begins and those that come to light later but relate to incidents that happened before the scheme started. We are in detailed discussions with Government on this issue, seeking to protect members’ financial and professional interests.

As with most of the questions on this proposed scheme we are awaiting more detail from the government before we can fully answer all the issues. We will update members when we know more.

The costs of the scheme will be met by NHS England. It will be centrally-funded through a one-off permanent adjustment to the global sum. Future costs of NHS practice under the scheme will be funded centrally, not met individually or by practices. Close

The scheme will cover GPs in England. In October 2017 former health secretary Jeremy Hunt announced that a new state-backed indemnity scheme would be introduced for GPs in England from April 2019. Read our reaction at the time here. Matt Hancock, Health secretary confirmed at the RCGP Conference in October 2018 that the scheme would be introduced from April 2019.

The Welsh government announced in November 2018 that their scheme will be aligned as far as possible to the scheme in England with further details provided in February 2019. You can access the latest Welsh government statement here.

There’s no reason for the other UK nations to follow suit given the totally different market. The issues are very different and, in MDDUS’ view, do not call for a similar response. Our subscription rates in Scotland are significantly lower than England and, in fact, lower than in 2001. Close

Absolutely. CNSGP will not cover you for non-NHS work, representation at inquests, GMC hearings and disciplinary investigations. Such situations can seriously impact your career and could ultimately result in you being struck off. The scheme will also not include advice and support – something highly prized by MDDUS members. It is therefore crucial that you have access to support and guidance from experienced medico-legal advisers.

That’s why the BMA has advised: "The scope of the state-backed scheme is to cover the cost of clinical negligence for NHS services. The MDOs will continue to play an important role in providing legal advice, representation for GMC hearings and also for the rare occasion where a criminal case occurs. Similar to hospital colleagues, it will be essential to maintain such medical indemnity."

Over the last 12 months alone, MDDUS have dealt with nearly 4,000 new cases from GP members and answered over 6,500 advice calls from GP members relating to these issues which will not be included in CNSGP. Close

It is important that you remain in membership of MDDUS as CNSGP will not provide you with the comprehensive range of benefits that you currently enjoy with us. Read more here. We will continue to offer you the peace of mind you have come to appreciate in this challenging environment. Further details of our MDDUS occurrence-based new product for GPs can be found here. Close

Yes. We know that the 24/7 service we provide for our members is greatly appreciated. There are a huge range of things where GPs will not get support under the new scheme and will need supplementary expert help. Provided you remain a member we will still be there to support you. Close

No. CNSGP will not assist you if you are involved in a GMC matter. It is important to remember that the GMC has the power to suspend, place restrictions on your practice, issue you with a warning and ultimately erase you from the register. With such potentially severe consequences there are a range of advantages of having representation and assistance from an MDO whose focus will be to ensure that your case is dealt with fairly and efficiently and that you are properly represented.

We have assisted over 200 members facing GMC investigations in the last 12 months. Latest figures from the GMC reveal that doctors appearing before disciplinary panels without legal representation are more likely to receive tougher sanctions. Nearly four fifths of doctors who were struck off the register at MPTS hearings in the last three years did not have any legal representation. Compare this to the 80 per cent of doctors who had legal representation and did not receive a sanction.

An individual can be found to be at fault at an inquiry or inquest and any criticisms made can lead to a GMC or a criminal matter being raised against you. With such high stakes it is important to have the support and guidance of a medico-legal adviser with the experience and insight to advise you on how to conduct yourself throughout such a formal and daunting process. MDOs which employ and retain some of the UK’s leading medico-legal solicitors can instruct the best legal representation, which will be made available to members free of charge. In the last 12 months alone we have assisted 513 GP members with coroner’s inquests. Close

The BMA recently reminded GPs of the importance of retaining their MDO subscription when CNSGP is introduced in April 2019. Advice from the BMA states that GPs “still need to retain membership of an MDO” and “MDOs will continue to play an important role in providing legal advice, representation for GMC hearings and also for the rare occasion where a criminal case occurs.”

You can read the BMA advice here and our statement welcoming the BMA advice here.

It is occurrence-based. Existing claims will continue to be managed by MDDUS. Members can be assured that MDDUS is fully funded and can meet both our known liabilities and our best actuarial estimate of the unknown ones.

This is one of the key details under discussion with DHSC. If we do not reach agreement with Government in current talks, members can be assured that, unlike some other organisations, MDDUS is fully funded and can meet both our known liabilities and our best actuarial estimate of the unknown ones. Close

We will continue to seek to meet the needs of our members as comprehensively and effectively as we can. We will certainly offer claims services to GPs across the UK for work that is not covered by CNSGP. In addition as mentioned above, GPs in England and Wales will still require cover for the areas this new scheme does not cover. Close

CNSGP has been designed in a similar manner to the NHS indemnity provided to your colleagues within secondary care. As a result CNSGP will only provide indemnity for NHS work and will not extend assistance to the individual practitioner’s professional issues e.g. assistance with disciplinary matters, GMC hearings, coroner’s inquests, Good Samaritan acts and non-NHS clinical work. Close

CNSGP only provides indemnity for work undertaken within a GMS, PMS and APMS contract along with other services delivered under a standard NHS contract. As a result you have a professional obligation to arrange indemnity for private clinical work, writing insurance reports, travel vaccination clinics etc. which MDDUS will provide. In addition, CNSGP does not extend assistance to the individual practitioner’s professional issues e.g. assistance with disciplinary matters, GMC hearings, coroner's inquests, Good Samaritan acts and non-NHS clinical work - but MDDUS will. Close

Those practising in the Isle of Man and the Channel Islands will not be entitled to indemnity via CNSGP. As a result it is important that you maintain your membership with MDDUS to ensure you meet the requirements of the GMC and have access to professional indemnity. Close

Not at all. You have shown your trust in us by moving in large numbers to MDDUS over the last decade – over a quarter of English GPs have come to us since 2010. The MDDUS Annual Reports over the last decade show that we have grown strongly and are on a sound financial footing.

We have two and a half times more members than when Crown indemnity for hospitals was introduced. We’ve done that by innovation and imagination, and we will continue to offer new products to healthcare professionals.

Our reserves are more than comfortably adequate to meet both our known and anticipated liabilities: that is, the claims and non-claims matters that have already been reported to us, as well as those where the incident has occurred but is not yet on our radar.

No and no. The market for dental indemnity is very different and fees are lower than for GPs. MDDUS offers particularly competitive subscription rates, which explains its recent rapid growth in England which we expect to continue. Close

The MOD have chosen not to be part of the scheme so GPs working for them will not be covered by CNSGP. Military doctors are covered under the terms of their engagement and we recommend that civilian GPs providing services to MOD facilities liaise with the MOD to ensure that these arrangements extend to them too. Close

The Medical and Dental Defence Union of Scotland Registered in Scotland No 5093 at Mackintosh House, 120 Blythswood Street, Glasgow, G2 4EA. The MDDUS is not an insurance company. All the benefits of MDDUS are discretionary as set out in the Articles of Association.